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The Matter of Gender-Questioning Youth

Last month I wrote about the feelings of guilt and shame and the concomitant behavior of secretiveness which I have found is pervasive in the early years of transgenders. There is currently a movement to remove the diagnosis of Gender Identity Disorder (GID) as applied to children from the diagnostic manual of mental disorders. As I understand the motivation of the supporters of this movement, it is to prevent the inhumane treatment of these children -- aversive techniques (electroshock therapy), behavioral conditioning approaches (rewards and punishments), and hospitalization -- in order to extinguish transgender identity.

There is however, little said by this movement about these children's real need for therapeutic support to deal with their guilt and shame surrounding their gender identity issues. It is this emotional response to a baffling condition that merits treatment. There is much that children have to accomplish in their formative years. They need to perfect physical skills, acquire a tremendous amount of information, develop relationships within and outside the family, learn to cope with authority, and develop judgment which will allow for increasing autonomy. When guilt and shame pervade the developing child's psyche and secretiveness inhibits his ability to express himself, psychic energy is diminished and the accomplishment of all tasks is made more difficult.

These children are suffering. They not only are upset by their gender dysphoria, their productivity, competence, judgment and maturity is affected, further contributing to the cycle of guilt and shame. Anyone interested in the welfare of children, transgender or not, should be willing to consider that given the current inability of society to nurture and admire these young people, psychotherapy may be an ameliorating factor in helping such youth develop to the best of their potential.

Interestingly, most cross-gender children display fewer cross-identified behaviors over time. By late adolescence, 3/4 of such boys no longer demonstrate the symptoms of GID, without the intervention of therapy. However, their psychological adjustment is not known. We do know, however, that children who are discriminated against, do poorly on school, and have a history of unfulfilling peer relationships, are vulnerable to developing low self-esteem and a host of neurotic symptoms as adults.

Instead of opposing the diagnosis of GID and therapy for gender-questioning youth, wouldn't it be more humane to prescribe treatment for the psychic consequences of this condition? Some believe that GID should be removed from the manual of mental disorders and relabeled as a physical condition. That possibility should receive serious consideration in view of our society's negative view of mental illness, but it does not address the need for psycho- therapy for real psychological problems.

Dr. Anderson is located at 1537 Franklin St, Suite 104, San Francisco, CA 94109, 415-776-0139.

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